What patients want:
This is our response to the plans for the allocation of the ‘Winter Access Funds’. NHS England and NHS Improvement (NHSEI) has made a £250 million Winter Access Fund available to primary care health services from November 2021 to March 2022 to improve patient access. There is considerable focus on increasing the number of face to face appointments.
Continuity
The great thing about how general practice works in this country is the continuity of care. That doesn’t mean seeing ‘your own’ doctor every time, but it means that you feel that your practice knows who you are, knows something about you and your circumstances, and takes you seriously. It means that you don’t have to start from scratch every time you have a consultation. It means that they know you will enough to recognise that something has changed and pick up on what might be a serious problem.
Flexibility: Urgent/Serious? Today or next week?
Many of us know when we need to be seen. Often the lack of flexibility of the appointment systems works against us – only offering a choice of today or in 2-3 weeks time. So something that could wait for a few days becomes ‘urgent’ in order to fit in with the options available to us.
Barriers to Equality of Access
The COVID pandemic has changed the way we get access to general practice. We can’t just walk into the surgery and make an appointment; we can’t make appointments on-line. Triage has become the norm. This is fine, providing that patients understand what to do and it works effectively for everyone.
Equal access regardless of IT access/ability
Telephone triage – you call the practice, explain your problem and they phone you back within a couple of hours, and sort you out immediately, or offer an appropriate solution works well for patients.
The rise of eConsult is a mixed blessing. It allows those patients with access to IT to ask for advice from their surgery 24/7. Maybe it is too easy? Does it lower the threshold of self-care?
But what about people who have no access to IT, or whose problem doesn’t fit neatly into the pre-defined categories, or who can’t explain what they think is the problem? Do they have a second class service?
Telephone, video, face to face?
There is no single answer to this. The answer will be different for every occasion for every person. From the patient viewpoint sometimes a quick phone call will suffice. Video calls also work – but only for those patients who have access to the technology and feel comfortable using it. Sometimes only a face to face appointment will do – especially if you need a physical examination of some kind.
The requirement to increase face to face appointments is a ‘red herring’. Many of us have no desire to sit in a waiting area full of sick (with COVID or otherwise) unless absolutely necessary.
More People
The underlying issue behind many of the difficulties in access is that there are not enough staff – clinical or administrative available to work in general practice. GPs take 10 years to train, nurses half that, so any amount (and it’s not a lot) of short term funding will not solve the problems.
There is no magic primary care team tree!
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Oxford Patient Network 